IMPAIRMENT-BASED ASSESSMENTS FOR PATIENTS WITH LATERAL ANKLE SPRAIN: A SYSTEMATIC REVIEW OF MEASUREMENT PROPERTIES

A.P. Schurz^1,2, J. Wagemans^1,3, C. Bleakley⁴, K. Kuppens³, D. Vissers^1,3, J. Taeymans^1,2

¹Bern University of Applied Sciences, Health, Bern, Switzerland, ²Vrije Universiteit Brussel, Faculty of Physical Education and Physiotherapy, Brussels, Belgium, ³University of Antwerp, Rehabilitation Sciences and Physiotherapy, Antwerp, Belgium, ⁴Ulster University, School of Health Sciences, Newtownabbey, United Kingdom

Background: The ankle is the most frequently injured body part in a variety of sports. Among these, lateral ankle sprain (LAS) is the most common injury. A lack of specific tests for objectively assessing primary impairments relating to acute lateral ankle sprain, led the International Ankle Consortium to develop the Rehabilitation-Oriented Assessment tool (ROAST). The content of ROAST was based primarily on expert consensus, and the measurement properties of its constituent tests and PROMs, have not been systematically evaluated.

Purpose: The aim of this systematic review is to examine the measurement properties of clinical tests used for assessing common impairments due to ankle sprain.

Methods: Following PRISMA and COSMIN guidelines, six electronic databases were searched until July 2022. Studies on measurement properties of specific tests and patient-reported outcome measurements (PROMs) in patients with acute LAS and history of LAS (>4 weeks post injury) including recurrent LAS and chronic ankle instability (CAI) were deemed eligible. The records retrieved during the searches were screened based on title, abstract and full text. Data was extracted independently by two reviewers.

Results: Forty-nine studies totaling 3313 participants met the inclusion criteria. Nine studies investigated acute LAS, 40 recurrent LAS, and CAI patients. Anterior Drawer Test (ADT) in supine position five days post injury and Reverse Anterolateral Drawer Test (RADT) are recommended in an acute setting in single studies. In the population of more than four weeks since injury, Cumberland Ankle Instability Tool (CAIT) (4 studies) as a PROM, Multiple Hop (3 studies) and Star Excursion Balance Tests (SEBT) (3 studies) for dynamic postural balance testing, all showed good measurement properties. No studies investigated pain, physical activity level and gait. Only single studies reported on swelling, range of motion, strength, arthrokinematics, and static postural balance. Limited data existed on responsiveness of the tests in both subgroups.

Conclusions: There was good evidence to support the use of CAIT as PROM, Multiple Hop, and SEBT for dynamic postural balance testing. Insufficient evidence exists in relation to test responsiveness, especially in the acute situation. Future research should assess measurement properties of clinical tests and PROMS of other impairments associated with lateral ankle sprains.

Implications: The current literature does not allow exclusion of specific outcomes from the ROAST guideline. Thus, pain, ankle mobility, gait and physical activity level should be assessed with the tests recommended by the expert group until new or more comprehensive literature is available. The Figure of Eight test for swelling assessment is still recommended. Arthrokinematic tests should continue to be performed with ADT and RADT as recommended by the ROAST guideline. If time is limited for patient evaluation possibly the examination of static postural balance could be excluded until new evidence exists. Star Excursion Balance Test and possibly the Multiple Hop Test can be used for dynamic postural control.

Funding acknowledgements: The author(s) received no specific funding for this work.

Keywords:
Chronic ankle instability
Ankle injury
Impairment-based assessment

Topics:
Sport & sports injuries
Musculoskeletal: lower limb
Disability & rehabilitation

Did this work require ethics approval? No

Reason: Systematic review